When a handbook on assisted suicide for dying people becomes a No. 1 best seller, it's worth looking at the fears that lie behind its popularity.
It's not so much the fear of death that has propelled Derek Humphry's "Final Exit" to the top of the charts as the fear of the dying process.
Dr. John Golenski, a Catholic theologian and ethicist, points out that Americans have a lot to fear in that process: They're afraid of pain, of bankrupting their heirs, of the loss of dignity, of isolation from their family and friends.
"Most Americans are right to fear those things because most Americans do die in horrific conditions," he says. "But if we stop acting like gods and goddesses all the time, maybe fewer Americans would fear death."
Often it does seem that our medical care system takes on God-like powers -- the power to decide when life will technically end, the power to pronounce death or to extend some semblance of life.
But those powers can also rob patients of the kind of death that allows dying people to live fully in the time they have left and of the kind of experience that helps their survivors achieve a fuller understanding and acceptance of their loss.
In "Death: The Final Stage of Growth," one of Elisabeth Kubler-Ross' most helpful books, Murray L. Trelease recalls his experiences in the 1960s as a priest serving Indian villages in the Alaskan interior, where he was frequently called on to minister to elderly, dying people.
In most cases, he says, these men and women almost seemed to plan their deaths. They were active participants in orchestrating the events of their final days and hours, bringing together family and friends, telling the story of their lives, saying farewell. Often, they would die only hours after the priest visited and administered communion.
These stories echo accounts of deaths from earlier times, when the real tragedy of death was not the end of life itself, but rather not having a forewarning that allowed one to prepare for death. As Philippe Aries notes in "Western Attitudes Toward Death from the Middle Ages to the Present," these forewarnings came usually in the form of natural signs or inner convictions, not magical or supernatural premonitions.
Forewarning allowed people to arrange themselves according to their customs. Christians would usually lie on their backs, so their faces would be turned toward heaven. Jews, according to Old Testament descriptions, would turn toward the wall when dying.
The warning also allowed people to gather their families, to pray or to speak their last words. Deathbed vigils could be social occasions, sometimes bringing into the room people from throughout the community whether they knew the dying person or not. Death was not an occasion for solitude or isolation.
These rituals lent dignity to the dying process and brought comfort to the dying person and the family. In various forms, these customs have persisted throughout history. But the sanitized, mechanized form of death many Americans now experience makes this kind of death impossible.
In short, we have lost the human touch in one of life's most basic events. Death has become hostage to technology. Too often, we aren't allowed the modern equivalent of a forewarning, the chance to stop fighting death long enough to allow ourselves to face it.
It is only human to long for some control over the way we die. That's the real reason "Final Exit" is a best seller.
Send your comments and questions about death and dying to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.